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Does Cycling Put me in Danger of Deep Vein Thrombosis?

Question: I’m in my 50s, a lifelong cyclist doing 175 -200 miles per week. As a result of earlier trauma to the lower leg and varicose veins, three years ago I had a deep vein thrombosis (DVT) that resulted in pulmonary embolisms (PE). Luckily the PEs were not big and I was soon back to riding while on Coumadin. Two weeks ago I got another DVT in the same leg, but caught it before it became a PE. I was doing a long, hard climbing ride on a hot day and was dehydrated, which might have contributed.

I’ve just started riding again, short miles, and I feel good although with some mild vein aches in that leg. I’m on Coumadin again and wearing compression. I’ve found very little info online about cycling and DVTs, and no scientific studies about it. Does cycling put me in danger? — Dave C.

Dr. Richard Ellin Responds: Deep vein thrombosis (DVT) is the medical term for a blood clot in one of the veins, most often one of the deep veins in the leg. These can occur spontaneously in people who are genetically at increased risk, and can occur as a result of other factors as well.

Some of these factors are: prolonged immobilization (such as a long car or plane trip, or prolonged bed rest), recent surgery, during and shortly after pregnancy, and due to certain medications (most commonly oral contraceptives). Certain cancers also can increase one’s risk of a DVT.

The symptoms of DVT can include swelling, redness, and warmth of the leg, and pain in the calf or thigh, although some people have no symptoms at all.

Typically, exercise involving the legs (cycling, walking, running) reduces the risk of deep vein thrombosis. I’m not aware of any data that show an increased risk with cycling.

When someone without apparent risk factors has a second venous thrombosis, as you did, Dave, we look for an underlying cause, such as a genetic predisposition.

In your case, presumably your doctors have already done so, but if not you should have a complete hypercoaguability workup (a battery of blood tests). You should also have a complete physical exam and complete screening for the common cancers that we can screen for (PSA for prostate cancer, colonoscopy, chest X-Ray).

Assuming nothing is found, in my opinion there’s no reason not to continue cycling. In my research, I have found no data that show a causative link or correlation between cycling and an increased risk of DVT.

You do raise a couple of other issues worth discussing here. First, cyclists need to pay attention to their hydration and stay hydrated. Too often, riders are underhydrated.

Also, cyclists need to stand and stretch while riding long distances. Doing so helps to avoid compression of the big veins in our legs.

Another thing to keep in mind is that all calf strains are not muscular in nature. DVT should be considered as a possible cause at some point. The literature is full of stories where cyclists went for medical help with calf pain and were treated as if they had a strain, only to wind up with a DVT. Early treatment of this problem can save a cyclist’s life and will allow a rider to return to cycling in a reasonable amount of time.

(Editor’s Note: RBR reader David Osler, who is a physician and suffered from a DVT resulting in a PE, contributed to this column.)

Richard Ellin, MD, FACP, is a board-certified specialist in Internal Medicine who practices in Alpharetta, Georgia. He received his medical degree and completed residency at Emory University, and has been in practice with Kaiser Permanente for 26 years. He is also an avid cyclist.

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British cycling are aware of this risk , some of there physios have guidance notes , i had dvt 2 years ago , i was un aware that british cycling knows of this concern untill last week when i saw a physio for a back problem , she has a friend who works there and its quite common knowledge. my dvt came from a poor fitting saddle , i had numbness for 2 weeks prior to the dvt .

Dear Dave, I just came across this forum. I also, developed a DVT after 100miles ride that ended up in a PE. I was in Xarelto which ended as a failure because after couple months a new CT was done and they found another clot in my long. Then, I was switch to Warfarin (Coumadin). Doctor said that I will have to take Warfarin for the rest of my life due to this two PE. I stopped Warfarin after 3 years and 1 years after I stopped I had another PE. Several test were completed and no genetic predisposition was found. Doctors doesn’t know the reasons but what they do know is that I shouldn’t stop my blood thinner medications which is now Eliquis. I never stopped bike riding but my assumptions are the following. Hydrations. Now, I don’t risk to be dehydrated and I have to stand up the bike more often because I frequently get numbness between my legs. My biggest worry was if I had any condition that I was going to pass to my boys but THANKS GOD the doctor said that she didn’t find any abnormal test that I could possibly pass onto my boys.

I am to new at clotting. Avid bicyclist great way to keep the weight down. Eliquis user. Numbness pressure in the ankles. Best to stay mobile always moving. I wear compression socks. Feel like support. Clots have traveled to my lungs. Doctors say I’m doing alright. Pain and swelling my take a year to hang around. I’m feeling the excess weight. Ready to do something for it. My medical history doesn’t go past me. Should I cycle

I have been on Warfarin for years (due to PE and DVT following idle periods (surgery/illness)); tested and have no genetic predispositions for clotting. After two 20 mile rides last week, I had a DVT in my leg. I am convinced that when you feel numbness (butt or leg), it is time to stand up for a period to get blood flowing.

I am also avid cyclist. Now 67 y.o. Retired fro 5 years. Cycled all my life. In my 40 I developed kidney stones from drinking coffee and Pepsicola during rides*a lot of it to hydrate the body….fool me!). About few years later I started suffering from swollen ankles. It became more and more clear that it happens when I consume sugar or things with preservatives. I visited various doctors and they told me I do not have diabetes (even Last year did).
But lately as I am riding with a large group in Spain about 300 km in a week (3 x 100 aprox.) I developed severe problem between my legs caused by either shorts or seat or both. Always when I bike my ankle swelling disappears. But 3 weeks ago I came home and about 3 hours later my both calves swelled and the right one was in pain> I thought it is a muscle. But then I also noticed unusually bad abrasion between the legs and bunch of small bumps,which looked like a hemorrhoid under the skin…..clearly smaller vain bulging out in little bumps…..when I looked closely under magnification mirror, when I stretched the skin, the bumps became bluish, just like hemorrhoids. I punctured some of them with desinfected needle and dark red blood came out.
So today I started to search for what it can be and found there is something like DVT….It is possible I have that,because my whole area under my sack and towards the sides feel painful and lightly swollen and the pain runs inside of my legs,when I sit for long time at the computer. I would say the way it feels is like the wains are in pain on the inside of my legs. Pain is just light and kind of dull and it terminates somewhere in area of calves.
And as I sit the pain worsens little bit and the ankle swelling gets also worse…..especially – as I said earlier,when I consume sugar or food with preservatives (like salami or canned stuff).
I will probably visit doctor fro possibility of DVT but the hemorrhage of the superficial veins under my sac is what…I do not find anything about it….. Can someone tell me what is it? It is now 3 weeks and it is almost gone,though the deep vain pain persists…..So far no Embolism I would know about.